Inequities in how individuals experience moments of crisis, such as a global pandemic like COVID-19, creates opportunities for governments to ‘build forward better’ using public policies that tackle the root of rising health inequities through systems change.

The aim of this NHMRC Funded ‘Ideas’ project is to build knowledge about how public policies contribute to systems change (i.e., shifts in rules, norms, power dynamics, and resource flows that stratify society) and the implications for health equity. We will do this by answering the following research questions:

1. What are measurable indicators of systems change relevant to evaluating the impacts of public policy on health equity?

2. In what ways do economic, labour market, and infrastructure policy subsystems contribute to systems change (ie. shifts in the rules, norms, power dynamics, and resource flows) relevant to health equity?

3. What are the likely impacts of Australia’s COVID-19 policy response on indicators of systems change relevant to health equity?

Project Description

Renewed attention to the inequities in peoples’ experience of crises, such as global pandemics like COVID-19, creates opportunities for governments to ‘build forward fairer’ using public policies that tackle the systemic drivers of health inequities – the rules, norms, power dynamics, and resource flows that stratify society. Despite growing acknowledgement of the need to redistribute power and privilege – little guidance exists on how to operationalise this for the purposes of monitoring and evaluation. We recently commenced a three-year programme of research which aims to develop and test a methodological toolkit for monitoring and evaluating the production and reproduction of power and privilege through the policy process and policy subsystems with the objective of contributing to action that reduces social stratification and health inequities. To do this we are: (1) using knowledge synthesis and consensus-building methods to operationalise the constructs of power and privilege; (2) employing systems-thinking to conceptualise the role of public policy processes and outputs in producing and reproducing power and privilege; (3) aggregating and distilling indicators of the social stratification of material and non-material resources; (4) mapping existing and ideal datasets against those indicators; and (5) testing this toolkit through the evaluation of selected infrastructure, investment, and labour policies in Australia. This presentation will introduce the project and present early results regarding the operationalisation of power and privilege and systems-thinking conceptualising the pathways by which the ‘making of’ and ‘doing of’ public policy produces and reproduces power and privilege. The objective of this presentation is to start a conversation regarding monitoring and evaluation of power and privilege in the policy process with key public health academics, practitioners, policymakers and other stakeholders.

Related Publications

1. Schram, A., Townsend, B., Mackean, T., Freeman, T., Fisher, M., Harris, P., Whitehead, M., van Eyk, H., Baum, F. and Friel, S., (2022). Promoting action on structural drivers of health inequity: principles for policy evaluation. Evidence & Policy 18 (4), 761-775.

2. Harris, P. (2023) Health policy analysis requires attending to institutions. International Journal of Health Policy and Management, 2023, 12(1), 8085

3. Harris, P., Baum, F., Friel, S., Mackean, T., Schram, A., Townsend, B. (2020) “A glossary of theories for understanding power and policy for health equity.” Journal of Epidemiology and Community Health. 74 (6), 548-552.

4. Schram, A., S. Friel, T. Freeman, M. Fisher, F. Baum, P. Harris. (2018) Digital Infrastructure as a Determinant of Health Equity: An Australian Case Study of the Implementation of the National Broadband Network. Australian Journal of Public Administration, 77(4), 829-842.

5. Lee, J, Schram, A., Riley, E., Harris, P., Baum, F., Fisher, M., Freeman, T., Friel, S. (2018) Addressing health equity through action on the social determinants of health: a global review of policy outcome evaluation methods. International Journal of Health Policy and Management. 7(7): 581–592.

 Funding Organisation

National Health and Medical Research Council ‘Ideas’ grant,  2013563

Partner Organisation

The CI team is from the Australian Research Centre for Health Equity (ARCHE) School of Regulation and Global Governance (RegNet), ANU and UNSW/CHETRE

Associate investigators are from Adelaide University, Deakin University, and Sydney University

Chief Investigators

Ashley Schram, Australian National University

Sharon Friel, Australian National University

Belinda Townsend, Australian National University

Patrick Harris, University of New South Wales

Project Team

Research Officer: Melanie Pescud

Associate Investigators (AIs)

Fran Baum, University of Adelaide

Lucie Rychetnik, University of Syndey/TAPPC

Melanie Pescud, Australian National University

Steven Allender, Deakin University